Photo by Yamhill County in Oregon Narcan is sprayed up the nose of an opioid overdose victim, restoring breathing and other functions in moments.

Fentanyl continues to take thousands of American lives daily, with the synthetic opioid impervious to all measures except for one thing — Naloxone.

Naloxone, or Narcan, is a medicine that rapidly reverses the effects of an opioid overdose and is responsible for saving nearly 27,000 lives, according to the Community Anti-Drug Coalitions of America (CADCA).

According to the California Department of Public Health, fentanyl is a major contributor to drug overdose deaths, with California experiencing 6,843 opioid-related deaths in 2021 — 5,722 of those deaths being related to fentanyl.

To save lives from fentanyl and other opioid overdose, the Food and Drug Administration has approved Narcan to be the first Naloxone product approved for use without a prescription.

This change is welcomed by pharmacists and public health departments across the state, including Fresno County.

Dr. John Zweifler, public health physician with the Fresno County Department of Public Health, said that the FDA’s decision to make Narcan available over the counter will help increase access to the lifesaving medicine.

“I think it’s great and it makes all the sense in the world,” said Zweifler. “The way you prevent overdoses as a harm reduction strategy is getting it out to the community. So how can you make it more readily available? You make it available over the counter.”

In August of 2021, the Fresno County Department of Public Health organized the Naloxone Distribution Program in an effort to assist Community Regional Medical Center (CRMC) in distributing the medication to the public. At the time CRMC, was the primary location offering the medication, according to James Sponsler, staff analyst with the Fresno County Department of Public Health. The interim health officer at the time, who also worked as an emergency room doctor, noted there was a high volume of patients coming in experiencing effects of an overdose. As a result, he asked the Public Health Department to set up a program to help distribute naloxone.

“We received our first shipment in August of 2021, and began shortly thereafter,” said Sponsler. “We made sure that individuals coming in would watch a short video on how and what Narcan will do because there’s a lot of people that know the drug is out there, but it’s so new that people are not aware of exactly how it works.”

Since the start of the Naloxone Distribution Program, 600,000 units of Narcan have been distributed with a reported 30,000 or so overdoses that have been reversed in Fresno County. Even though Narcan will be available over the counter, there is still a need for cost-reduced services that will provide the medication to underserved communities, said Sponsler.

“Cost is a significant issue about whether they’re going to get this medication, and I think that’s where we’re going to see this project continue to grow because we’re able to offer it free of charge,” said Sponsler. “If it’s over the counter at a pharmacy, then they’re going to have to pay for that medication itself.”

While costs vary, two Narcan doses can cost as much as $50 or more.

A major supporter of the FDA’s decision is the California Pharmacists Association, the largest state association representing the pharmacy profession, including those in the Central Valley. According to Michael Conner, the president-elect of the association, increased access to Narcan will help the Central Valley save more lives, especially those affected by fentanyl overdose.

According to the California Department of Public Health, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine.

“We’re very excited that this was approved for over-the-counter use because it’ll give greater access at a time where we’re still seeing significant overdoses that are leading to death, particularly around fentanyl,” said Conner. “The FDA has approved it because not only do they find it safe, but they believe that the communities and patients can use it quite readily and easily.”

According to the Centers for Disease Control and Prevention, Naloxone can restore normal breathing within two to three minutes in an individual whose breathing has slowed or stopped because of an opioid overdose.

Based on EMS data from Fresno County, courtesy of Fresno County Department of Public Health, ambulances in Fresno County are administering two Narcan reversals per day.

“That doesn’t sound like much, but it’s significant from a few years ago, where it was maybe an every-other-day thing, now it’s twice a day,” said Sponsler.

To help reduce the cases of fentanyl overdoses in Fresno County, the Fresno Needle Exchange Program has distributed 150 units of Narcan on a weekly basis and reports 25 to 30 reversals per week, according to Zweifler.

“So, there’s a lot of Narcan distribution that’s going on currently, but more is needed as we continue to see overdoses related to opioids,” said Zweifler.

In January, Fresno County reported that the number of fentanyl-related deaths jumped from two to 15, a 650% increase. Number of deaths increased by another 173% to 41 in 2020, and again in 2021 with 114 fentanyl-related deaths, marking a 178% increase over 2020.